Atypical Context

I traded comments and some email with Liz Spikol yesterday. I was a bit imprecise in my thoughts on Seroquel over the last couple of days—OK, I had neglected to add a bit of context—so let me address this.

My criticisms of Seroquel—and other atypicals used for bipolar disorder—are limited to its use as a long-term maintenance med in bipolar disorder (ie, not in its long-term use in schizophrenia). Of course, AstraZeneca is trying to build the case for its use as a long-term maintenance med in bipolar disorder, which they can then call a mood stabilizer. Regular readers know my what my problems are with Seroquel, used as long-term maintenance med. I won't bother repeating them here. (When it comes to schizophrenia, there are no better treatment options than an antipsychotic, sadly.)

I do, however, think that Seroquel and other atypicals can be valuable short-term tools in treating bipolar. They are much more a velvet hammer type of medication than the old antipsychotics ever could be, and are quite useful in treating acute mania and in nuking depression. Despite a rough ride for me using the med long-term, I still use it for a day or two perhaps twice a year to knock down bouts of depression that I'd prefer don't spiral out of control. I won't use it any longer because its side effects are awful—who else doesn't like feeling like they drank a fifth of whiskey the night before?—and depression is generally something I am willing to bulldog my way through without taking neutron bombs to get me through the day.

Besides, when I took Seroquel and other atypicals long-term, I still had bouts of depression, so my incentive to take these meds long-term is zero. And I had the same kind of breakthroughs on all the other anti-depressants I took back when (again, we're talking long-term use here). Prozac, Paxil, Zoloft, Luvox, Wellbutrin and Lexapro: none of those anti-depressants worked especially well at killing off my depression and Prozac damn near killed me. After all of those meds (plus atypicals later on), I decided I would rely on my own resources in dealing with depression. It's worked out pretty well (I have fewer depressions than when I was on all that other junk—just to be clear for newbies, I now take Lamictal alone), plus my approach is cheaper and has fewer side-effects.

All the same, I ought to come up with a standard disclaimer to use each time I talk about atypicals so that people will be aware of the distinction I make between short-term and long-term use of these meds. If I have to type it anew each time, I'll lose my mind.